AdherenceAdherence

"active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of

behavior to produce a therapeutic result“

It is the term used to indicate the actual cooperation of a patient in carrying out

recommended directions and actions for the prevention or treatment of a diseas

"active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of

behavior to produce a therapeutic result“

It is the term used to indicate the actual cooperation of a patient in carrying out

recommended directions and actions for the prevention or treatment of a diseas

ComplianceCompliance

"the extent to which a person's behavior

coincides with medical advice"

"the extent to which a person's behavior

coincides with medical advice"

NoncomplianceNoncompliance

Means that patients disobey the advice of their

health care providers

Means that patients disobey the advice of their

health care providers

Compliance is the one area that providers can't

control

It is estimated that 30% to 70% of the recommended regimens are not followed

To improve patient adherence, it is

important to understand why nonadherence

occurs!!!!???

To improve patient adherence, it is

important to understand why nonadherence

occurs!!!!???

The greatest success adherence is attained:

1- Believes that he or she is susceptible to the disease 2- Is Convinced that the disease can be prevented 3- Understands that prevention is preferable to disease . 4- Knows that he or she can modify the course of the disease

SELECTING METHODS OF INFLUENCING BEHAVIOR

ALTERATION

Many patients are willing to cooperate in employing health care procedures if they understand the reasons behind

the recommended treatment

The approach used to influence or to inform the patient should be guided by individual’s needs, motives, and

self-established value

Authoritarian or Nonauthoritarian Styles

The two ways for health professional to

relate to patients

Authoritarian

-Forceful -doing most of the talking and -Advice giving -with the patient expected to listen and to obey

-Forceful -doing most of the talking and -Advice giving -with the patient expected to listen and to obey

Advantages of the Authoritarian Style

1-Some patients welcome the authoritarian approach, because it frees them from the responsibility of decision making; in this scenario the responsibility for initiating, altering, or maintaining the desired behavior remains in the hands of the authoritarian not in the hands of the patient

2-Sometimes the authoritarian approach is absolutely necessary like in times of emergency when correct decisions must be made quickly to avoid life-threatening events

3-It is justified in dealing with individuals not capable of decision making; such as the young and the mentally retarded

Disadvantages of the Authoritarian Style

1-Authority often generates resentment and temporary grudging compliance, as long as the external pressure is being applied

2-Excessive fear arousal leads to unpredictable behavior and the blocking out of other important information

3-Also, direct frontal attacks on personal value systems are often counterproductive. The confronted person may avoid the professional in the future or may even retaliate

Nonauthoritarian approach

seeks to develop the potential of the patient's desire to satisfy

his or her needs

The health professional and the patient conjointly explore the

various preventive options and planning objectives

Nonauthoritarian approach

Learning and change best take place when a person is free to reject

change

This freedom of choice allows the patient to be his or her true self, thus increasing the possibility of

learning new behavior(Carl Roger’s Paradox self theory)

Failure to show sensitivity to the feelings of others destroys the foundation of mutual trust and cooperation

Failure to show sensitivity to the feelings of others destroys the foundation of mutual trust and cooperation

Accurate Empathy: Emotional Understanding

Accurate Empathy: Emotional Understanding

Human communication is essentially an exchange of feelings not information …. People seldom think. They

always feel(Mittelman)

Human communication is essentially an exchange of feelings not information …. People seldom think. They

always feel(Mittelman)

Accurate Empathy

Patients are allowed to have their own feelings and are appreciated for being

themselves, regardless of their behavior

Even though we have great difficulty in sharing our patients emotions, we should appreciate and be aware of

those feelings

Patients are allowed to have their own feelings and are appreciated for being

themselves, regardless of theirbehavior

Even though we have great difficulty in sharing our patients emotions, we should appreciate and be aware of

those feelings

Environment

One of our most important tasks as

professionals and as employers is to provide

a growth enhancing environment

If we create a repressive, inhibiting, or

punitive environment, those around us will fail

to self-actualize (eg, their natural growth

processes will become distorted or diminished)

Modeling or Vicarious Learning

One of the most important ways that people learn new behaviors and are motivated to maintain such behaviors is by observing

others

One of the most important ways that people learn new behaviors and are motivated to maintain such behaviors is by observing

others

Credibility gap

To us as health professionals this means that our patients are going to look at us as being important models, especially in the area of

health behavior

If we don’t act as we say this gap often results in distrust or

cynicism on the part of thoseexposed to such situations

To us as health professionals this means that our patients are going to look at us as being important models, especially in the area of

health behavior

If we don’t act as we say this gap often results in distrust or

cynicism on the part of those exposed to such situations

Behavioral Change Strategies

for the Patient

What strategies are available to eliminate the old behavior to

substitute the new?

1- Positive thinking 2- Behavioral self-control

1-Positive Thinking

States that:“you can, if you think you can"

It concentrates on developing a positive attitude about succeeding at any given-task and of developing a positive self

image

The fundamental quality that an individual must possess to engage in

such an approach is will power

States that:"you can, if you think you can“

It concentrates on developing a positive attitude about succeeding at any given task and of developing a positive self-

image

The fundamental quality that an individual must possess to engage in

such an approach is will power

2- Behavioral Self-Control

Behavior and attitudes are learned and then are maintained or altered by both environmental

influences (cues) and the resultant consequences of

that behavior

Michael Mahoney and Carl Thoresen))

For successful self-control:

(1) Self-Observation specification of the behavior to be changed,

(2) Environmental Planning identification of the behavior's previous environmental cues, and

(3) Behavioral Management implementation of a plan to alter the cues or consequences or both as needed

1-Self-Observation

Paying attention to the behavior of interest and, very importantly, recording the level of occurrences

of the behavior

Several benefits arise from careful monitoring of one's own behavior:

(1 )increased self- awareness ,

(2 )immediate quantitative feed back on what we are doing or not doing, and

(3 )information about the environmental cues and subsequent consequences

Research has demonstrated that

keeping careful records of behaviors alone can alter

their frequency

2 -Environmental Planning

involves changing the environment so as to change

the cues preceding a behavior

Often this requires the elimination or avoidance of situations that trigger the

undesired behavior

3- Behavioral Management

Deals with changing the consequences of a behavior rather than the triggering

event or situation

One approach commonly used is the “when-then" principle

Client Reinforcement

External Reinforcement

&Internal

Reinforcement

Positive Reinforcement(External)

Desired behavior must be rewarded to enhance the probability of its being

repeated

Internal Reinforcement

In terms of self-praise and feelings of accomplishment as

means of motivating the maintenance of our new behavior

In terms of self-praise andfeelings of accom plishment as

means of motivating themaintenance of our new behavior

Patients deserve to know the cause of their dental

diseases and how they can prevent them

This is a responsibility for the health educatorOnce armed with the

knowledge, however, the patient reserves the right to

remain sick

In the final analysis, prevention is a shared responsibility between the practitioner and the patient

In the final analysis, prevention is a shared responsibility between the practitioner and the patient